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Development and validation of a nomogram for assessing comorbidity and frailty in triage: a multicentre observational study

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Abstract

Assessing patient frailty in the Emergency Department (ED) is crucial; however, triage frailty and comorbidity assessment scores developed in recent years are unsatisfactory. The underlying causes of this phenomenon could reside in the nature of the tools used, which were not designed specifically for the emergency context and, thus, are difficult to adapt to the emergency environment. The objective of this study was to create and internally validate a nomogram for identifying different levels of patient frailty during triage. Multicenter, prospective, observational exploratory study conducted in two ED. The study was conducted from April 1 to October 31, 2022. Following the triage assessment, the nurse collected variables related to the patient’s comorbidities and chronic conditions using a predefined form. The primary outcome was the 90-day mortality rate. A total of 1345 patients were enrolled in this study; 6% died within 90 days. In the multivariate analysis, the Charlson Comorbidity Index, an altered motor condition, an altered cognitive condition, an autonomous chronic condition, arrival in an ambulance, and a previous hospitalization within 90 days were independently associated with death. The internal validation of the nomogram reported an area under the receiver operating characteristic of 0.91 (95% CI 0.884–0.937). A nomogram was created for assessing comorbidity and frailty during triage and was demonstrated to be capable of determining comorbidity and frailty in the ED setting. Integrating a tool capable of identifying frail patients at the first triage assessment could improve patient stratification.

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Data available on request from the authors.

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Funding

This research received no specific grant from any funding agency in the public, commercial, or not-for-profit sectors.

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Authors and Affiliations

  1. Innovation, Research and Teaching Service (SABES-ASDAA), Teaching Hospital of the Paracelsus Medical Private University (PMU), Bolzano, Italy

    Arian Zaboli & Francesco Brigo

  2. Institute of Nursing Science, University of Basel, Basel, Switzerland

    Serena Sibilio

  3. Department of Emergency Medicine, Hospital of Merano-Meran (SABES-ASDAA), Merano-Meran, Italy

    Gabriele Magnarelli & Norbert Pfeifer

  4. Lehrkrankenhaus der Paracelsus Medizinischen Privatuniversität, Salzburg, Austria

    Gabriele Magnarelli & Norbert Pfeifer

  5. Department of Internal Medicine, Intermediate Care Unit, Hospital Alto Vicentino (AULSS-7), Santorso, Italy

    Gianni Turcato

  6. Innovation, Research and Teaching Service, Azienda Sanitaria dell‘Alto Adige, Via Alessandro Volta, 13A, Bolzano, Italia

    Arian Zaboli

Authors
  1. Arian Zaboli
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  2. Serena Sibilio
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Contributions

Arian Zaboli: conceptualization, methodology, investigation, formal analysis, data curation, writing-original draft preparation; Serena Sibilio: investigation, writing—original draft preparation; Gabriele Magnarelli: investigation, resources; Norbert Pfeifer: supervision; Francesco Brigo: supervision, writing—original draft preparation, writing—review and editing; Gianni Turcato: conceptualization, methodology, investigation, formal analysis, data curation, writing-original draft preparation.

Corresponding author

Correspondence to Arian Zaboli.

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Conflict of interest

We have no conflicts of interest to disclose.

Ethical approval

This study was approved by the Local Ethics Committee (Approval Number 95–2019) and was conducted according to the tenets of the Declaration of Helsinki, adhering to Ethical Principles for Medical Research Involving Human Subjects.

Patient consent statement

When the patient entered triage and presented the criteria for inclusion, they were asked for their consent to collect their personal data. It was made clear that nothing would change during the stay and the journey within the emergency department.

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Zaboli, A., Sibilio, S., Magnarelli, G. et al. Development and validation of a nomogram for assessing comorbidity and frailty in triage: a multicentre observational study. Intern Emerg Med (2024). https://doi.org/10.1007/s11739-024-03593-9

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